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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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lunes, 29 de junio de 2015

tPA en AVC isquémico (ACEP 2015)

University of Texas - Houston
Emergency Medicine literature of Note - Posted by Ryan Radecki - June 29, 2015
“Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department” - Approved by the ACEP Board, June 24, 2015

The highlights:
  • The Level A suggestion to consider the risk of ICH with tPA administration has been eliminated. It has been moved, nonsensically into the Level B recommendations for offering tPA – when, frankly, it’s the only consistent finding across all the evidence.
  • The Level B recommendation in which tPA “may be given” within 3 hours has been strengthened to “should be offered and may be given”. Obviously, a profound difference.
  • The Level B recommendation for 3-4.5 hours remains unchanged, based on only one flawed piece of Class II evidence (ECASS III), and conflicting Class III evidence (ATLANTIS, IST-3, meta-analyses).
  • The Level C recommendation to engage in shared decision-making now states “when feasible”, which is obviously open to interpretation.
  • No further clarification of “carefully selected patients” or “systems … in place to safely administer the medication” is provided.
http://www.emlitofnote.com/2015/06/the-new-improved-acep-clinical-policy.html